Exceptional Experiences at Community Health Network

Research shows that dosing errors and accidental ingestions are the leading causes of rare adverse events in young children.  The leading manufacturers of oral OTC pediatric cough and cold medicines are voluntarily transitioning the labeling on oral OTC pediatric cough and cold medicines to state “do not use” in children under four years of age.  These modified labels will continue to provide dosing information for children four and older.

For products containing certain antihistamines, manufacturers are voluntarily adding new language that warns parents not to use antihistamine products to sedate or make a child sleepy.

The Consumer Healthcare Products Association has also expanded its national education program to focus on educating parents and caregivers to:

• Follow the dosing recommendations exactly and use the measuring device that comes with the medicine,
• Do not give a medicine only intended for adults to a child,
• Do not use two medicines at the same time that contain the same ingredients,
• Prevent unsupervised ingestions by keeping all medicines out of the reach and sight of children,
• Do not use antihistamine products to make a child sleepy,
• Consult a physician or healthcare professional with questions.

RSV season is approaching and it might be worth reviewing the guidelines on diagnosis and management of bronchiolitis. The American Academy of Pediatrics(2006) makes the following recommendations for children 1 month to 2 years of age:

Well-designed randomized controlled trials or diagnostic studies on relevant populations point to the consideration of palivizumab(Synagis) prophylaxis in children with congenital heart disease, chronic lung disease, or prematurity (< 35 weeks of gestation).

Observational studies with consistent findings or limited randomized controlled trials find that we should:

Avoid routine use of

• Antimicrobial meds unless bacterial co-infection is apparent
• Bronchodilators (a careful monitored trial may be useful)
• Chest physiotherapy
• Corticosteroids
• Laboratory testing and radiologic studies for diagnosis
• Ribavirin

Always

• Closely monitor the weaning of supplemental oxygen in infants with a past medical history that includes congenital heart disease, chronic lung disease, or prematurity.
• Consider the use of alcohol-based rubs for hand decontamination.
• Decontaminate hands after patient contact, any contact with inanimate objects in direct patient vicinity, and after glove removal.
• Rely primarily upon history and physical exam to make the diagnosis.

The videoconference was hosted by Freedom Calls Foundation, a non-profit organization that provides a satellite network to connect deployed troops in Iraq with their loved ones at home free of charge. In the week leading up to the mother’s delivery, members of the IS department worked with Freedom Calls to set up the connection.

“It was our first time working with Freedom Calls,” says Susan Dine, R.N., IT site director at Community Hospital North. “It required a lot of collaboration within IT, and we learned a lot of valuable lessons in bringing this experience to the patient.”

The setup included a bedside table with a laptop that had a Webcam on top. Both video and audio were transmitted, so the mother and father could see and talk to each other throughout the delivery. “I was in the room when the dad first came up on the screen,” says Dine. “There was a gasp, and then a lot of tears. It was very memorable for everyone involved.”

The nursing staff was instrumental in creating a meaningful experience for the father. Jeannie Amoroso, R.N., was present for the entire birthing process and controlled the position of the camera. “At delivery I made sure dad got a good shot at seeing the delivery as he wanted,” she says. “After delivery, I took the camera to the baby and showed him all the neat little things about his son.”

One week later, IT staff at Community Hospital South coordinated a Webcast so that Taunya Staley-Middleton could have her husband “by her side” during the birth of their second child. The baby’s father, James Middleton, is serving in Iraq as a MP with the 38th division of the Indiana National Guard. According to Desiree Tarter, patient concierge at Community Hospital South, “I was so impressed to see that everyone worked so well and so fast to make this happen for this family. It was very rewarding to come in later after the baby was born and see dad on the computer screen, smiling from ear to ear.”

Using Freedom Calls and other Webcast technologies, Community is able to provide an exceptional experience to families who are separated by 8,000 miles. Community North has a second Freedom Calls video conference scheduled for another expecting military family in November.

Construction of the Next Evolution of Community Hospital South is underway. The new facility, which includes a five story, all-private room patient tower, expanded operating suites and convenient outpatient services will create en exceptional experience for patients, families, physicians, nurses and employees. But did you know it’s also being designed with the environment in mind?

“We are incorporating as much energy efficiency as possible and doing what we can to optimize indoor air quality,” says Mitchell Breeze, director of facilities at Community Hospital South.

Following environmentally friendly standards involves registering the project with the Green Guide for Health Care and the U.S. Environmental Protection Agency’s Energy Star program. A similar approach was taken with the recent expansion of the hospital’s emergency department, which received gold certification from the Leadership in Energy and Environmental Design (LEED) Green Building Rating System™.

According to Breeze, the guidelines for the Next Evolution project are difficult to achieve, particularly for a hospital building. “We’re building on the lessons learned from our last LEED project,” he says.

The list of goals for the environmental component of the project is lengthy. Among the items on the checklist:

• At least 75 percent of the equipment purchased will be EPA Energy Star or Enerlogic rated.
• At least 75 percent of the construction waste will be diverted away from landfills through recycling and reuse.
• Water consumption in the new facilities will be reduced through the use of low-flow and hands-free technology.
• Finishes and paints that are low in odorous or irritating contaminants will be selected to ensure the comfort and well-being of patients, families, employees—and those involved in the construction.
• Every effort will be made to keep sound disruptions to a minimum, throughout the construction and beyond.
• Native or adapted plants requiring little or no irrigation will be used for the outdoor landscaping.

Taking the extra steps to achieve Green Guide and Energy Star certification is a win-win for the environment and for the occupants of the new facilities. In particular, patients and visitors will benefit from the reductions in noise and air pollution, which will contribute to the healing environment.

Learn more about the Next Evolution of Community Hospital South at eCommunity.com/south.

From: PEDIATRICS (doi:10.1542/peds.2008-2449)

Recommendations have been expanded to include all children ages 6 months to 18 years of age.  Household members and out-of-home care providers for all children at high risk, adolescents, and all children under 5 years of age should also be immunized.  Also, as usual, health care professionals and pregnant women should receive the vaccination.

The number of vaccine doses is age dependent.  Children over the age of 9 who have never received an influenza vaccine only need one dose in their first season of being immunized.  Any child under 9 years of age, receiving an influenza vaccine for the first time, should receive a second dose, four weeks after later.  Children under 9 who received only one dose in previous seasons should receive 2 doses in the following season.  This only applies “to the influenza season that follows the first year that child younger than 9 years receives an influenza vaccine.”

Efforts to immunize patients should begin at the onset of flu season and continue through May 1st as there can be multiple peaks of activity in one season.